Provider Demographics
NPI:1982226429
Name:MENDEZ HERNANDEZ, YADIRA E
Entity Type:Individual
Prefix:
First Name:YADIRA
Middle Name:E
Last Name:MENDEZ HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10820 SW 200TH DR APT 234S
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-8418
Mailing Address - Country:US
Mailing Address - Phone:786-312-4149
Mailing Address - Fax:
Practice Address - Street 1:10820 SW 200TH DR APT 234S
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-8418
Practice Address - Country:US
Practice Address - Phone:786-312-4149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-116280106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician